Department of Radiology, University of Michigan, 1500 E Medical Center Dr, B1 132H Taubman Center, Ann Arbor, MI 48109-5302, USA.
AJR Am J Roentgenol. 2013 Jun;200(6):1317-26. doi: 10.2214/AJR.12.9215.
The purpose of this article is to present, through systematic review of recent literature, a comparative effectiveness analysis of ultrasound elastography versus B-mode ultrasound features for differentiating thyroid nodules.
We conducted an extensive literature search of PubMed and other medical and general purpose databases from January 1966 through March 2012. Eligible studies were published in English, reported diagnostic performance of elastography (using elasticity score or strain ratio) with or without B-mode ultrasound in differentiation of thyroid nodules, and used histology or cytology as the reference standard. Summary diagnostic performance measures were assessed for each of the elasticity measuring methods and ultrasound features by means of a bivariate random effects model.
Twenty-four studies provided relevant information on more than 2624 patients and 3531 thyroid nodules (927 malignant and 2604 benign). Six ultrasound features (echogenicity, calcifications, margins, halo sign, shape, and color Doppler flow pattern) were compared with elasticity score and strain ratio. The respective sensitivities and specificities were as follows: elasticity score, 82% and 82%; strain ratio, 89% and 82%; hypoechogenicity, 78% and 55%; microcalcifications, 50% and 80%; irregular margins, 66% and 81%; absent halo sign, 56% and 57%; nodule vertical development, 46% and 77%; and intranodular vascularization, 40% and 61%.
Evaluation of thyroid nodules with ultrasound elastography appears to be both more sensitive and specific than each of the ultrasound features. The former is a safe and effective technique that warrants further rigorous investigation or use in the clinical diagnosis of thyroid nodules.
本文通过对近期文献的系统回顾，旨在对超声弹性成像与 B 型超声特征在鉴别甲状腺结节方面的比较效果进行分析。
我们对 1966 年 1 月至 2012 年 3 月期间的 PubMed 及其他医学和一般用途数据库进行了广泛的文献检索。纳入的研究均为英文发表，报道了弹性成像（使用弹性评分或应变比）的诊断性能，无论是否结合 B 型超声，用于鉴别甲状腺结节，并以组织学或细胞学作为参考标准。使用双变量随机效应模型对每种弹性测量方法和超声特征的汇总诊断性能指标进行评估。
24 项研究提供了超过 2624 例患者和 3531 个甲状腺结节（927 个恶性和 2604 个良性）的相关信息。将 6 种超声特征（回声、钙化、边界、晕环征、形状和彩色多普勒血流模式）与弹性评分和应变比进行了比较。相应的敏感性和特异性如下：弹性评分分别为 82%和 82%；应变比分别为 89%和 82%；低回声分别为 78%和 55%；微钙化分别为 50%和 80%；不规则边界分别为 66%和 81%；无晕环征分别为 56%和 57%；结节垂直生长分别为 46%和 77%；内部血管化分别为 40%和 61%。
与各超声特征相比，超声弹性成像评估甲状腺结节的表现似乎更敏感、更特异。该技术安全有效，值得进一步进行严格的研究或用于甲状腺结节的临床诊断。
